999 EMS Research Forum Prioritisation of topics for

999 EMS Research Forum Prioritisation of topics for research in prehospital care 999 emsrf@swansea. ac. uk

• The 999 EMS Research Forum is a partnership of academics, clinicians, prehospital care practitioners and managers, formed in 1999, whose aim is to encourage, promote and disseminate research and evidence based policy and practice in 999 healthcare. 999 emsrf@swansea. ac. uk

Review of research in prehospital care for DH • Objectives – identify and reviews – identify the limitations and strengths of existing prehospital care evidence – identify ongoing research and planned delivery of results – match existing research evidence with current policy developments to identify gaps – identify priority areas for further research, with associated timescales and type of research required 999 emsrf@swansea. ac. uk

Sources of policy documents & guidelines: • • • Emergency Care policy documents published by the Dept. of Health at: http: //www. dh. gov. uk/en/Policyandguidance/Organisationpolicy/Emerg encycare/index. htm Cochrane Prehospital and Emergency Health Field Website NHS National Library for Health Emergency Care Specialist Library Emergency Care web pages at the Health Services Research Institute of Warwick University Service Delivery Organisation webpages at http: //www. sdo. lshtm. ac. uk National Institute for Clinical Excellence guidance National Service Frameworks References of policy documents obtained Joint Royal Colleges Ambulance Liaison Committee (JRCALC) website (key points related to treatment included) 999 emsrf@swansea. ac. uk

Sources of prehospital research literature: • • • Pub. Med Web of Science The Cochrane Library HMIC (Health Management Information Consortium) DUETs (Database of Uncertainties about the Effects of Treatment) • The National Research Register • HTA research publications list • Ongoing and recently completed research listed on the HTA, SDO and Cochrane Library websites 999 emsrf@swansea. ac. uk

Drafting of list for prioritisation • Table of policy matched to evidence • Gaps highlighted • Combined with list of topics of research from Ambex 2006 conference session • Circulated to wide group to identify omissions (done) • Further circulation (two stages) planned to achieve ranking of: – Topic areas – questions 999 emsrf@swansea. ac. uk

Topic area examples • Access – call handling and despatch • Rise in demand • Pre-999 call • Emergency call management • Access – 999 emergency response • Management and operations • • Organisation of EMS Workforce Service users Information • Services - Alternatives to ambulance/A&E • Direct referral to specialist care • Management outside A&E • Helicopters • Treatments - Clinical interventions • Children, trauma, airways, diabetes, stroke, chest pain, seizures, nausea

Questions Rise in demand • Understanding the causes of the rise in demand for emergency calls • epidemiology of the rise in demand for emergency calls • developing interventions to manage the increase • Understanding how services are being used and variations and inequalities in access, service user decision making • Effects of publicity campaigns for appropriate use of 999 service 999 emsrf@swansea. ac. uk

Questions Workforce • Skills and competencies in the EMS workforce • Training of paramedics in primary care skills • PTSD in ambulance personnel: prevalence and effectiveness of interventions • workforce safety - hazards in community response 999 emsrf@swansea. ac. uk

Questions Trauma management • MAST suit for subgroups of patients • Investigation into variations in the treatment and management of ankle fractures • Use of spinal boards (Literature review) • Airway management • Intravenous fluid administration 999 emsrf@swansea. ac. uk

Delphi circulation list • • • • British Paramedic Association Research Committee JRCALC Committee Ambulance service medical/clinical directors (DOCCs) Ambulance service R&D leads International representatives from Europe and USA Ambulance service trust chief executive Operations director of an ambulance service trust Faculty of Prehospital Care Research Committee INVOLVE and/or the Patients’ Forum College of Emergency Medicine BASICS the British Association for Immediate Care Royal College of GPs 999 EMS Research Forum Board Thematic Research network for emergency and Un. Scheduled Treatment (TRUST) Board members If you want to be included contact: 999 emsrf@swansea. ac. uk

Method • Delphi exercise with 2 rounds • Every stakeholder asked to score questions AND topics • Score 1 not important to 9 most important • Questions and topics ranked by scores • Re-circulated and re-scored What’s important?

What’s important? • Related to Vo. I • Based on – Burden of disease • Size of patient group • Severity of condition – Uncertainty about best care, etc • No evidence, weak evidence, etc – Potential (therapeutic) impact • Size of possible effect – Cost

Dissemination • DH • Publication • Use to help funding bodies decide on priorities New funding opportunities - CSR uplift to £ 1. 7 Bn - New programmes in translational medicine, public health, methods, e-health - substantial expansion for HTA, SDO, etc